Sunday, June 10, 2018

EMRO MERS-CoV Summary - May


Nearly a month ago, due to what appears to be an ongoing redesign of the Saudi MOH website, daily updates to the MERS-CoV surveillance portal halted, and all existing data since January 23rd of this year vanished from the site.
This comes after several months of increasingly erratic and often belated posting of cases. Hopefully all of this is temporary, and the website will evenutally be made fully functional again. 
At the same time, however, we've not seen a detailed WHO DON report from Saudi Arabia (with case line listing) since January of this year, easily the longest lull in reporting since the MERS virus emerged in 2012.

Two weeks ago, in WHO: UAE MERS-CoV Case & IHR Concerns, an updated line listing of cases was published, but it contained no new entries from Saudi Arabia since the middle of January.  
All of which means that - for now, at least - we are pretty much dependent upon the abbreviated WHO EMRO monthly MERS summary reports to keep track MERS activity in Saudi Arabia.
Although we hear very little from a tightly controlled Saudi media - (ranked by Reporters Without Borders as 169th worst of 180 Countries) - on May 28th we began to pick up unconfirmed reports of a family cluster in Najran, which cited anywhere from 6 to 12 cases.
Three days later, in Confirmation Of Najran MERS-CoV Cluster via ProMed Mail), 7 cases were confirmed via an email from the Saudi Assistant Deputy Minister for Preventive Health;  Abdullah Assiri.
Today, via the latest EMRO Surveillance report, we learn that number has risen to 8 confirmed cases, and that additional cases are expected. 
MERS situation update, May 2018
Highlights, May 2018
  • At the end of May 2018, a total of 2220 laboratory-confirmed cases of Middle East respiratory syndrome (MERS), including 790 associated deaths (case–fatality rate: 35.6%) were reported globally; the majority of these cases were reported from Saudi Arabia (1844 cases, including 716 related deaths with a case–fatality rate of 38.8%). During the month of May, a total of 12 laboratory-confirmed cases of MERS were reported globally: 11 cases in Saudi Arabia including 1 associated death and one case reported in United Arab Emirates.
  • A household cluster of 8 laboratory-confirmed MERS cases was reported in Najran Region during the last week of May. Apart from the index case, who had history of contact with camels and also consumed raw camel milk before he was diagnosed, none of the remaining seven cases in this cluster had any history of contact with camels. The index case had a date of onset of symptoms on 17 May 2018 and by 31 May, seven symptomatic secondary cases were reported from this cluster. More cases are expected to be reported from this cluster as the close contacts are being followed up and the laboratory test result of some of the close contacts are awaiting.
  • The demographic and epidemiological characteristics of reported cases, when compared during the same corresponding period of 2013 to 2018, do not show any significant difference or change. Owing to improved infection prevention and control practices in hospitals, the number of hospital-acquired cases of MERS has dropped significantly since 2015.
  • The age group of 50–59 years continues to be at highest risk for acquiring infection of primary cases. The age group 30–39 years is most at risk for secondary cases. The number of deaths is higher in the age group 50–59 years for primary cases and 70–79 years for secondary cases.”

The current lack of daily MERS updates is disappointing, but the Saudis are under no obligation to publicly post them. They are, however, bound by the terms of the 2005 IHR (International Health Regulations) to report certain disease outbreaks and public health events to WHO in a timely manner.  
While obviously some information is being relayed, the lack of a detailed WHO report for well over 4 months is both curious and concerning.
That said - despite the ongoing frustration over the lack of timely and accurate information - the good news is we've seen no signs of any sustained or efficient transmission of the MERS virus outside of health care facilities or (rarely) large households.

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